From the Department of Anesthesia, Section on Critical Care Medicine, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Outcomes Research Consortium, Cleveland, Ohio.
A A Pract. 2020 Jul;14(9):e01266. doi: 10.1213/XAA.0000000000001266.
Vasodilatory shock is common following cardiac surgery, caused by an inflammatory response to cardiopulmonary bypass (CPB). Some cases are refractory to volume resuscitation, high-dose catecholamines, arginine vasopressin, and established adjunctive therapies. Angiotensin II (ANG-2), an endogenous hormone in the renin-angiotensin-aldosterone system (RAAS), has several direct and indirect vasoconstrictive properties that make it a promising potential treatment. This case describes the successful use of ANG-2 in an anephric patient who suffered from severe refractory shock following CPB, offering a unique potential mechanism of benefit in a broader population of patients with baseline impaired RAAS.
血管扩张性休克在心脏手术后很常见，是心肺转流（CPB）引起的炎症反应所致。有些病例对容量复苏、大剂量儿茶酚胺、精氨酸加压素和已建立的辅助治疗方法有抵抗力。血管紧张素 II（ANG-2）是肾素-血管紧张素-醛固酮系统（RAAS）中的内源性激素，具有多种直接和间接的血管收缩特性，使其成为一种有前途的潜在治疗方法。本病例描述了在一名肾切除患者中成功使用 ANG-2 的情况，该患者在 CPB 后发生严重难治性休克，为基线 RAAS 受损的更广泛患者群体提供了一种潜在的独特获益机制。
